A bad position of wear.

[drk]

Have a moderate hyperopic presbyope who actually prefers to wear her glasses halfway down her nose.

My optician recommended we compensate (somehow) for this, but I said "no".

Well, now she can't find the near zone when she reads. Which isn't suprising on a +2.50 progressive fit on-pupil that has slidden down and out.

So, what is the logical "POW" compensation, here? My only thoughts are to increase the fitting height, and make the the PAL design short and wide (which describes the patient, BTW).

Thoughts?

[uncut]

vertex, height, and prism compensation.....or a lecture about "growing up"......or a eyelash manicure..........or a multifocal contact lens fitting...............with a +0.50 to wear over..........

[optical24/7]

Cut some of the add also to compensate for the induced magnification the longer vertex will create. The weaker add will also produce a wider field of view at near.

[drk]

Thank you for the answers. The grown-up parts, only.

[EyeCare Rich]

I don't want to sound rude, but listen to your optician, they might know what they are talking about. If they are trained correctly, they will know how to take care of your patient, keeping them happy, and you happy as well.

[drk]

I'm not giving her my password to Optiboard, so there.

[jpways]

And you're sure that's she's happy with distance, just like you're inducing extra plus at near, you're inducing extra plus at distance, I'm surprised that the patient's not also complaining that she can't see as far (assuming she's just not wearing her glasses down that far to look over the glasses at distance but that's a different issue).

[NCspecs]

I would have said/done the same thing as your Optician. Oh well.

[Robert Martellaro]

I'm not giving her my password to Optiboard, so there.

Any decent optician would've hacked that PW years ago.

Don't shorten the corridor- the increase in vertex distance will, for any angle of down gaze, put the near optics higher in her field (less ocular rotation is required to reach the near zone). A standard corridor length should be fine. For the same reason, lower the fitting height slightly (not lower than the present position, but lower than center pupil when looking straight ahead). Note the optics and position of the old eyeglasses.

Hope this helps,

[drk]

Good points, Robert. I think I'm backwards...

[Paul Smith LDO]

Quick question, was the PAL fit with the frame half way down her nose. If not, then the fitting height needs to be modified. As to a standard corridor vs a short it is always best to take a look at her current lens design. When fitting my patients who like to wear their glasses down their nose I have had better success with a short corridor as they reach their near more comfortably.

[Chris Ryser]

Simple solution ----------------------------> make her a half eye.................or turn the progressive upside down

[Optician1960]

POW measurements are fine to compensate. I might also suggest trial framing with the total reading power "with" the frame sitting were she will wear it. Back off on the add until she is really comfortable to get all 3 (patient, Drk and optician) of you comfortable with the final Rx including what it would be compensated to...

[AngeHamm]

Quick question, was the PAL fit with the frame half way down her nose. If not, then the fitting height needs to be modified. As to a standard corridor vs a short it is always best to take a look at her current lens design. When fitting my patients who like to wear their glasses down their nose I have had better success with a short corridor as they reach their near more comfortably.

+1. I've seen this over and over.

[Robert Martellaro]

http://books.google.com/books?id=sV5...height&f=false